HIV Testing Centers May Be Appropriate Venues for Domestic Violence Screening and Counseling

A new study by Duke global health researchers recommends domestic violence screening and counseling be administered at HIV voluntary counseling and testing (VCT) centers. The study is among the first of its kind to provide evidence on the prevalence and risk factors associated with domestic violence in northern Tanzania.

Of more than 2,400 women interviewed at an HIV VCT site in the Kilimanjaro Region of Tanzania, one in five women reported physical or sexual violence during their lifetime, and a third of those women experienced violence frequently. The study also found that among women with a history of violence, 78% reported physical violence, 61% reported sexual violence and 39% reported both at least once in their lifetime.

Published in International Journal of Gynecology & Obstetrics this week, the study suggests that most women are at risk for domestic violence and identifies risk factors for the most vulnerable population. Researchers found that domestic violence, defined in this study as intimate partner violence (IPV), was reported more often among women who are older, unemployed, less educated, married or divorced, and have children. Also, women with IPV were more likely to suspect HIV or infidelity in their sexual partner or have a sexual partner who has multiple partners.

The study, led by senior author Nathan Thielman, has important implications for nongovernmental organizations and policy makers since domestic violence places an increasingly recognized burden on women’s health and public health worldwide. For instance, violence can increase the risk of HIV transmission via coercion into sexual intercourse, decreased ability to negotiate the use of condoms, and increased sexual risk-taking behaviors.

“Intimate partner violence is a common occurrence, including in resource-poor settings, and is both a risk factor for and a consequence of HIV,” said Thielman, associate professor of medicine, pathology and global health.  “The key policy implication of this work is that HIV-testing services can readily be used to screen, counsel and refer women who are at risk for or are victims of intimate partner violence.”

“Because VCT counselors gain the trust of their clients, and because many women have little access to other services addressing IPV, HIV testing sites, which are widespread in many resource-poor settings, can serve as a central point to connect victims of IPV to available medical, legal and support services within the community,” said first author Malavika Prabhu, a fourth-year medical student at Stanford University School of Medicine and 2009-2010 Fogarty International Clinical Research Scholar who conducted the research at Kilimanjaro Christian Medical Centre (KCMC) in partnership with Duke, the Hubert-Yeargan Center for Global Health, and DGHI. “Moreover, integrating HIV testing with IPV screening and counseling may improve the adherence to HIV treatment regimens, particularly among couples seeking VCT services.”

Because the study’s finding on the high prevalence of domestic violence is likely an underestimate due to cultural acceptance of IPV as well as reticence to report sensitive information, the authors emphasized the importance for widespread screening for both HIV and IPV.
Other researchers on this study include Bariki Mchome, Jan Ostermann, Dafrosa Itemba and Bernard Njau.

The research was conducted at a women-led, community-based HIV/AIDS advocacy, education and home-care organization called KIWAKKUKI: Women Against AIDS in Kilimanjaro.  The KIWAKKUKI-Duke VCT Study Group also includes John Bartlett, John Crump, Keren Landmann, Anna Mgonja, Antipas Mtalo, Florida Muro, Sabina Mtweve and Jeffrey Wilkinson.

The Duke VCT study was supported in part by the NIH Fogarty International Center through the International Clinical Research Scholars Program at Vanderbilt University, the Fogarty International Center AIDS International Training and Research Program, the Duke Clinical Trials Unit, the International Studies on AIDS Associated Coinfections award and the Hubert-Yeargan Center for Global Health.